Hoskins vows to upend local health care

Controversial community care access centres to be scrapped, insiders say, as health minister calls for ‘bold’ structural changes

A major restructuring of the province’s health system is on the way, bringing big changes at the community level, says Health Minister Eric Hoskins.

Insiders say this means the controversial community care access centres (CCACs) are on their way out. CCACs are charged with co-ordinating access to home and community care services, including nursing, physiotherapy and personal care.

Part of the system for almost two decades, they have come under fire for delivering uneven levels of care across the province, giving big raises to their CEOs, and being too administration-heavy.

Opposition politicians have long called for scrapping them. So has the Registered Nurses’ Association of Ontario (RNAO). The centres also came under heavy criticism from the provincial auditor last month, and earlier this year by an expert panel the province commissioned to study how well the home and community care system is working.

Until now, the government has steered clear of addressing structural reform. But in a speech to the Ontario Hospital Association on Wednesday, Hoskins said it’s time to upend the status quo, in hopes of bringing services closer to those who need them, breaking “the cycle of poor health outcomes,” and addressing inequities across the province.

“Now the time has come for us to have a conversation about the structure of the system,” he told an audience of 1,000 health professionals at the Metro Toronto Convention Centre, saying he wants to consult with them and the public as he moves forward.

While he stopped short of saying he will gut the CCACs, observers reading between the lines of his speech and senior officials in the health system say he is laying the groundwork to dismantle the centres.

“It would certainly appear CCACs are on their way out,” said one senior health official, who spoke on the condition of anonymity.

Hoskins did not refute this in an interview, saying only that “all op- tions are on the table.”

In his speech, the minister said the health system needs to be better coordinated at the local level, and that the province’s local health integration networks (LHINS) will play a bigger role on that front.

The14 LHINS, which have the same boundaries as the 14 CCACs, were created in 2007 to plan and integrate local health services and to deliver provincial funding to them.

Critics have long questioned the need to have both bodies, claiming they overlap and are weighed down by bureaucracy. The acronyms are meaningless to most Ontarians, who often struggle to navigate the confusing health system.

Hoskins acknowledged there’s a need to consider changes. “We should ask ourselves: To deliver better results for our patients, to deliver more equitable access to the services our population needs, is it time to reconsider the relationship between our CCACs and the LHINs?”

He offered assurances to CCAC workers who have been nervous about losing their jobs, saying their services will still be needed, but in a transformed system: “Home-care leadership, our co-ordinators and our care providers … all of them are essential, and their functions remain necessary in an integrated future.”

Doris Grinspun, CEO of the nursing association, has been calling for CCACs to be phased out for three years. She has proposed that the LHINS and the primary care system take over the work they do. (Primary care is the first point of contact for patients in the health system — for example, family doctors working with nurses.)

“Once their functions are moved to the LHINS and primary care, the CCACs will be gone,” Grinspun said.

Getting rid of CCACs will save $500 million that could be reinvested in front-line home care, she said.

Last month, Ontario Auditor General Bonnie Lysyk released a report that found nearly 40 per cent of the $1.5 billion the province spends on CCACs doesn’t go into “face-to-face” treatment of patients.

A report commissioned by the province and released in March found the home and community care system is failing patients and needs to be more accountable, transparent and co-ordinated.

Star columnist Bob Hepburn last year reported that the CEOs of CCACs across the province had received raises of up to 27 per cent.

“Now the time has come for us to have a conversation about the structure of the system.” ERIC HOSKINS HEALTH MINISTER, TO AN AUDIENCE OF 1,000 HEALTH PROFESSIONALS